It’s something you might not want to contemplate: what happens to surgeons who don’t really shine during training for their chosen specialty? Do they get the equivalent of social advancement and, thus, are turned loose to operate regardless of their competency? Or are they held back in the interest of preventing yet another malpractice suit?

Credit: Flickr user get directly down

That discussion unfolded as Dr. J. Eric Jelovsek of the Cleveland Clinic presented data on a study of ob-gyn surgical residents and fellows showing that it was possible to set training standards and establish minimum cut-offs proving competency. Currently, surgical skills are not assessed by any licensing body or by the American Board of Obstetrics and Gynecology, said Dr. Jelovsek.

All of the surgeons-in-training in the trial — whose operations were videotaped and evaluated by experts — proved to be competent at performing vaginal hysterectomy, Dr. Jelovsek said.

But many of the surgeons in the audience wondered aloud whether instructors in the OR had subtly influenced performance through coaching — and thus invalidated results. And, of more concern, they said, was what happens to residents and fellows who don’t meet such competency cut-offs.

Dr. Jelovsek said that the cut-offs have been used at Cleveland Clinic to tell trainees they should not attempt vaginal hysterectomy for the first year in practice without supervision or to say “we highly advise you do not perform this procedure in your practice.” Some have been held back for another year of training.

But there was a clear sense of unease among attendees.

One questioner raised the specter of litigation and asked if results for incompetent trainees might be considered “discoverable” by plaintiffs’ attorneys. Dr. Jelovsek advised surgeons to check laws in their states.

3 responses to “Where Do Incompetent Surgical Trainees Go?”

Are we talking about people who are deemed fundamentally unable to master a skill despite any amount of training? I mean, unless you’re lacking appendages yourself, or you have, like, 1 eye, couldn’t these people just go through the training program again and again until they attain competence?

It is sort of a catch-22; everyone wants the surgeon who has done the procedure a thousand times, but how are new surgeons supposed to get better?
I agree that new surgeons should somehow demonstrate a minimum standard of competence before they make the cut, so to speak.
But I also think it’s no coincidence that the foot surgery I had years ago went very well because my podiatrist has done tons of them.
–Heidi Splete (on twitter @hsplete)